nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1044Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФизические нагрузки во время сеанса гемодиализа: комплаентность и эффектыIntradialysis physical training: compliance and effectsВишневскийК. А.VishnevskiyK. A.noemail@neicon.ruЗемченковА. Ю.ZemchenkovA. Yu.zemchenkov@nephro.ruКомашняА. В.KamoshnyaA. V.noemail@neicon.ruДидурМ. Д.DidurM. D.noemail@neicon.ruГерасимчукР. П.GerasimchiukR. P.noemail@neicon.ruГородская Мариинская больница – Городской нефрологический центр, г. Санкт-ПетербургРоссияMariinsky City Hospital – City Nephrologica Center, St.-PetersburgRussian FederationСанкт-Петербургская Государственная Медицинская Академия им. И.И. МечниковаРоссияSt.-Petersburg I.I. Mechnikov State Medical AcademyRussian FederationСанкт-Петербургский Государственный Медицинский Университет им. акад. И.П. ПавловаРоссияI.P. Pavlov St.-Petersburg State Medical universityRussian Federation200919062025114302309Copyright © Вишневский К.А., Земченков А.Ю., Комашня А.В., Дидур М.Д., Герасимчук Р.П., 20252025Вишневский К.А., Земченков А.Ю., Комашня А.В., Дидур М.Д., Герасимчук Р.П.Vishnevskiy K.A., Zemchenkov A.Y., Kamoshnya A.V., Didur M.D., Gerasimchiuk R.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1044

Снижение физической активности у пациентов с ХБП широко распространено, является независимым предиктором неблагоприятных исходов и не корригируется диализными технологиями или медикаментозно. Программы интрадиализных и междиализных аэробных и силовых тренировок способны повлиять на ряд метаболических, гемодинамических и реабилитационных параметров. Выраженность достигаемого эффекта зависит от приверженности пациента программе тренировок. Индекс комплаентности отражает эффективность обучения и контроля за исполнением программы и связан с достигнутыми результатами. В ходе годовой программы интрадиализных тренировок у 10 пациентов в сравнении с контрольной группой была достигнута лучшая динамика ряда показателей: нутриционных (увеличение толщины кожно-жировой складки и окружности мышц плеча), воспалительных (снижение логарифма уровня С-реактивного белка), эффективности диализа (уменьшение фосфатемии) и качества жизни (улучшение витальности и физического суммарного компонента по опроснику KDQoL-SF ).

Decreased physical activity in CKD patients is widely prevalent and related with outcome worsening. Programs of intradialysis and interdialysis physical training are able to improve metabolic, hemodynamic and rehabilitation parameters. Efficacy of such programs depends on adherence to physical training schedule. The compliance index reflects patient’s education quality and surveillance efficiency and related with achieved results. During 12-months intradialysis training program of 10 stable HD patients improvement of some nutritional (triceps skin fold thickness, upper arm muscle circumference), inflammation (decrease of CRP logarithm), dialysis efficiency (phosphatemia) and quality of life (vitality and physical component summary of the KDQoL-SF questionnaire) parameters were found compared to control group of HD patient without physical training.

физические тренировкикомплаентностьадекватность гемодиализакачество жизниphysical exercisecompliancehaemodialysis adequacyquality of lifeReferencesВасильева И.А. Российская версия опросника Kidney Disease and Quality of Life – Short Form (KDQOL-SF™) – ценного диагностического инструмента для оценки качества жизни больных на диализе // Нефрология. 2007. № 11 (1). С. 64–70.Васильева И.А. Российская версия опросника Kidney Disease and Quality of Life – Short Form (KDQOL-SF™) – ценного диагностического инструмента для оценки качества жизни больных на диализе // Нефрология. 2007. № 11 (1). С. 64–70.Земченков А.Ю., Сапон Н.Г., Костылева Т.Г., Герасимчук Р.П., Вишневский К.А., Земченков Г.А. Оценка качества жизни у пациентов на гемо- и перитонеальном диализе с помощью опросника KDQOL-SF™ // Нефрология и диализ. 2009. № 11 (2). С. 94–102Земченков А.Ю., Сапон Н.Г., Костылева Т.Г., Герасимчук Р.П., Вишневский К.А., Земченков Г.А. Оценка качества жизни у пациентов на гемо- и перитонеальном диализе с помощью опросника KDQOL-SF™ // Нефрология и диализ. 2009. № 11 (2). С. 94–102Anderson J.E., Stewart K.J., Hatchett L. Ambulatory blood pressure (ABP) and pre and post hemodialysis (HD) blood pressure are lower after 3 months of exercise training // J Am Soc Nephrol. 2001. Vol. 12. P. 319A.Anderson J.E., Stewart K.J., Hatchett L. Ambulatory blood pressure (ABP) and pre and post hemodialysis (HD) blood pressure are lower after 3 months of exercise training // J Am Soc Nephrol. 2001. Vol. 12. P. 319A.Borg G. A category scale with ratio properties for intermodal and interindividual comparisons. In. Geissler H.G., Petzolds P. eds. Psychophysical judgment and process of perception // Berlin: VEB Verlag der Wissenschaften. 1982. P. 25–34.Borg G. A category scale with ratio properties for intermodal and interindividual comparisons. In. Geissler H.G., Petzolds P. eds. Psychophysical judgment and process of perception // Berlin: VEB Verlag der Wissenschaften. 1982. P. 25–34.Carney R., Templeton B., Hong B. et al. Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients // Nephron. 1987. Vol. 47. P. 194–198.Carney R., Templeton B., Hong B. et al. Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients // Nephron. 1987. Vol. 47. P. 194–198.Cheema B., Abas H., Smith B., O'Sullivan A., Chan M., Patwardhan A., Kelly J., Gillin A., Pang G., Lloyd B., Fiatarone Singh M. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD. the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study // Am J Kidney Dis. 2007. Vol. 50 (4). P. 574–584.Cheema B., Abas H., Smith B., O'Sullivan A., Chan M., Patwardhan A., Kelly J., Gillin A., Pang G., Lloyd B., Fiatarone Singh M. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD. the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study // Am J Kidney Dis. 2007. Vol. 50 (4). P. 574–584.DePaul V., Moreland J., Eager T., Clase C.M. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO. A randomized controlled trial // Am J Kidney Dis. 2002 Vol. 40. P. 1219–1229.DePaul V., Moreland J., Eager T., Clase C.M. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO. A randomized controlled trial // Am J Kidney Dis. 2002 Vol. 40. P. 1219–1229.Goldberg A.P., Geltman E.M., Hagberg J.M. et al. Therapeutic benefits of exercise training for hemodialysis patients // Kidney Int. 1983. Vol. 24. S303–S309.Goldberg A.P., Geltman E.M., Hagberg J.M. et al. Therapeutic benefits of exercise training for hemodialysis patients // Kidney Int. 1983. Vol. 24. S303–S309.Harter H.R., Goldberg A.P. Endurance exercise training an effective therapeutic modality for hemodialysis patients // Med Clin N Am. 1985. Vol. 69. P. 159–175.Harter H.R., Goldberg A.P. Endurance exercise training an effective therapeutic modality for hemodialysis patients // Med Clin N Am. 1985. Vol. 69. P. 159–175.Headley S., Germain M., Mailloux P. et al. Resistance training improves strength and functional measures in patients with end-stage renal disease // Am J Kidney Dis. 2002. Vol. 40. P. 355–364.Headley S., Germain M., Mailloux P. et al. Resistance training improves strength and functional measures in patients with end-stage renal disease // Am J Kidney Dis. 2002. Vol. 40. P. 355–364.Jette M., Posen G., Cardarelli C. Effects of an exercise program in a patient undergoing hemodialysis treatment // J Sports Med Phys Fitness. 1977. Vol. 17 (2). P. 181–184.Jette M., Posen G., Cardarelli C. Effects of an exercise program in a patient undergoing hemodialysis treatment // J Sports Med Phys Fitness. 1977. Vol. 17 (2). P. 181–184.Johansen K.L. Exercise in the end-stage renal disease population // J Am Soc Nephrol. 2007. Vol. 18 (6). P. 1845–1854.Johansen K.L. Exercise in the end-stage renal disease population // J Am Soc Nephrol. 2007. Vol. 18 (6). P. 1845–1854.Johansen K.L. Physical functioning and exercise capacity in patients on dialysis // Adv Renal Replace Ther. 1999. Vol. 6 (2). P. 141–148.Johansen K.L. Physical functioning and exercise capacity in patients on dialysis // Adv Renal Replace Ther. 1999. Vol. 6 (2). P. 141–148.Kathy E. Sietsema, Antonino Amato, Sharon G. Adler, Eric P. Brass. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease // Kidney International. 2004. Vol. 65. P. 719–724.Kathy E. Sietsema, Antonino Amato, Sharon G. Adler, Eric P. Brass. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease // Kidney International. 2004. Vol. 65. P. 719–724.KDOQI. Клинические Практические Рекомендации по Питанию при Хронической Почечной Недостаточности (перевод на рус. яз.). http.//www.nephro.ru/standard/; http.//www.kidney.org/professionals/kdoqi/guidelines_rus/doqiforeign.html.KDOQI. Клинические Практические Рекомендации по Питанию при Хронической Почечной Недостаточности (перевод на рус. яз.). http.//www.nephro.ru/standard/; http.//www.kidney.org/professionals/kdoqi/guidelines_rus/doqiforeign.html.Kong C.H., Tattersall J.E., Greenwood R.N., Farrington K. The effect of exercise during haemodialysis on solute removal // Nephrol Dial Transplant. 1999. Vol. 14. P. 2927–2931.Kong C.H., Tattersall J.E., Greenwood R.N., Farrington K. The effect of exercise during haemodialysis on solute removal // Nephrol Dial Transplant. 1999. Vol. 14. P. 2927–2931.Konstantinidou E., Koukouvou G., Kouidi E., Deligiannis A., Tourkantonis A. Exercise training in patients with end-stage renal disease on hemodialysis. Comparison of three rehabilitation programs // J Rehabil Med. 2002. Vol. 34 (1). P. 40–45.Konstantinidou E., Koukouvou G., Kouidi E., Deligiannis A., Tourkantonis A. Exercise training in patients with end-stage renal disease on hemodialysis. Comparison of three rehabilitation programs // J Rehabil Med. 2002. Vol. 34 (1). P. 40–45.Kouidi E., Grekas D., Deligiannis A., Tourkantonis A. Outcomes of long-term exercise training in dialysis patients. Comparison of two training programs // Clin Nephrol. 2004. Vol. 61. Suppl 1. S31–38.Kouidi E., Grekas D., Deligiannis A., Tourkantonis A. Outcomes of long-term exercise training in dialysis patients. Comparison of two training programs // Clin Nephrol. 2004. Vol. 61. Suppl 1. S31–38.Levendoğlu F., Altintepe L., Okudan N., Uğurlu H., Gökbel H., Tonbul Z., Güney I., Türk S. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients // J Nephrol. 2004. Vol. 17 (6). P. 826–832.Levendoğlu F., Altintepe L., Okudan N., Uğurlu H., Gökbel H., Tonbul Z., Güney I., Türk S. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients // J Nephrol. 2004. Vol. 17 (6). P. 826–832.Lo C.Y., Li L., Lo W.K., Chan M.L., So E., Tang S., Yuen M.C., Cheng I.K., Chan T.M. Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis // Am J Kidney Dis. 1998. Vol. 32. P. 1011–1018.Lo C.Y., Li L., Lo W.K., Chan M.L., So E., Tang S., Yuen M.C., Cheng I.K., Chan T.M. Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis // Am J Kidney Dis. 1998. Vol. 32. P. 1011–1018.Miller B.W., Cress C.L., Johnson M.E., Nichols D.H., Schnitzler M.A. Exercise during hemodialysis decreases the use of antihypertensive medications // Am J Kidney Dis. 2002. Vol. 39 (4). P. 828–833.Miller B.W., Cress C.L., Johnson M.E., Nichols D.H., Schnitzler M.A. Exercise during hemodialysis decreases the use of antihypertensive medications // Am J Kidney Dis. 2002. Vol. 39 (4). P. 828–833.Molsted S., Eidemak I., Sorensen H.T., Kristensen J.H. Five months of physical exercise in hemodialysis patients. Effects on aerobic capacity, physical function and self-rated health // Nephron Clin Pract. 2004. Vol. 96. P. 76–81.Molsted S., Eidemak I., Sorensen H.T., Kristensen J.H. Five months of physical exercise in hemodialysis patients. Effects on aerobic capacity, physical function and self-rated health // Nephron Clin Pract. 2004. Vol. 96. P. 76–81.Moore G.E., Parsons D.B., Stray-Gundersen J., Painter P.L., Brinker K.R., Mitchell J.H. Uremic myopathy limits aerobic capacity in hemodialysis patients // Am J Kidney Dis. 1993. Vol. 22. P. 277–287.Moore G.E., Parsons D.B., Stray-Gundersen J., Painter P.L., Brinker K.R., Mitchell J.H. Uremic myopathy limits aerobic capacity in hemodialysis patients // Am J Kidney Dis. 1993. Vol. 22. P. 277–287.Moug S., Grant S., Creed G., Boulton Jones M. Exercise during haemodialysis. West of Scotland pilot study // Scott Med J. 2004. Vol. 49. P. 14–17.Moug S., Grant S., Creed G., Boulton Jones M. Exercise during haemodialysis. West of Scotland pilot study // Scott Med J. 2004. Vol. 49. P. 14–17.Mustata S., Chan C., Lai V., Miller J.A. Impact of an Exercise Program on Arterial Stiffness and Insulin Resistance in Hemodialysis Patients // J Am Soc Nephrol. 2004. Vol. 15 (10). P. 2713–2718.Mustata S., Chan C., Lai V., Miller J.A. Impact of an Exercise Program on Arterial Stiffness and Insulin Resistance in Hemodialysis Patients // J Am Soc Nephrol. 2004. Vol. 15 (10). P. 2713–2718.Nakagawa S., Cuthill I.C. Effect size, confidence interval and statistical significance. a practical guide for biologists // Biological Reviews. 2007. Vol. 82 (4). P. 591–605.Nakagawa S., Cuthill I.C. Effect size, confidence interval and statistical significance. a practical guide for biologists // Biological Reviews. 2007. Vol. 82 (4). P. 591–605.Nindl B.C., Headley S.A., Tuckow A.P. et al. IGFI system responses during 12 weeks of resistance training in end-stage renal disease patients // Growth Horm IGF Res. 2004. Vol. 14. P. 245–250.Nindl B.C., Headley S.A., Tuckow A.P. et al. IGFI system responses during 12 weeks of resistance training in end-stage renal disease patients // Growth Horm IGF Res. 2004. Vol. 14. P. 245–250.Oh-Park M., Fast A., Gopal S. et al. Exercise for the dialyzed. Aerobic and strength training during hemodialysis // Am J Phys Med Rehabil. 2002. Vol. 81. P. 814–821.Oh-Park M., Fast A., Gopal S. et al. Exercise for the dialyzed. Aerobic and strength training during hemodialysis // Am J Phys Med Rehabil. 2002. Vol. 81. P. 814–821.Ouzouni S., Kouidi E., Sioulis A., Grekas D., Deligiannis A. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients // Clinical Rehabilitation. 2009. Vol. 23 (1). P. 53–63.Ouzouni S., Kouidi E., Sioulis A., Grekas D., Deligiannis A. Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients // Clinical Rehabilitation. 2009. Vol. 23 (1). P. 53–63.Painter P., Carlson L., Carey S., Paul S.M., Myll J. Low-functioning hemodialysis patients improve with exercise training // Am J Kidney Dis. 2000. Vol. 36. P. 600–608.Painter P., Carlson L., Carey S., Paul S.M., Myll J. Low-functioning hemodialysis patients improve with exercise training // Am J Kidney Dis. 2000. Vol. 36. P. 600–608.Painter P., Carlson L., Carey S., Paul S.M., Myll J. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients // Am J Kidney Dis. 2000. Vol. 35. P. 482–492.Painter P., Carlson L., Carey S., Paul S.M., Myll J. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients // Am J Kidney Dis. 2000. Vol. 35. P. 482–492.Painter P., Moore G.E., Carlson L. et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life // Am J Kidney Dis. 2002. Vol. 39. P. 257–265.Painter P., Moore G.E., Carlson L. et al. Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life // Am J Kidney Dis. 2002. Vol. 39. P. 257–265.Painter P.L., Nelson-Worel J.N., Hill M.M., Thornbery D.R., Shelp W.R. Harrington A.R., Weinstein A.B. Effects of exercise training during hemodialysis // Nephron. 1986. Vol. 43 (2). P. 87–92.Painter P.L., Nelson-Worel J.N., Hill M.M., Thornbery D.R., Shelp W.R. Harrington A.R., Weinstein A.B. Effects of exercise training during hemodialysis // Nephron. 1986. Vol. 43 (2). P. 87–92.Parsons T.L., Toffelmire E.B., King-Van Vlack C.E. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure, and quality of life in end-stage renal disease patients // Clin Nephrol. 2004. Vol. 61. P. 261–274.Parsons T.L., Toffelmire E.B., King-Van Vlack C.E. The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure, and quality of life in end-stage renal disease patients // Clin Nephrol. 2004. Vol. 61. P. 261–274.Ridley J., Hoey K., Ballagh-Howes N. The exercise during hemodialysis program. Report on a pilot study // CANNT J. 1999. Vol. 9. P. 20–26.Ridley J., Hoey K., Ballagh-Howes N. The exercise during hemodialysis program. Report on a pilot study // CANNT J. 1999. Vol. 9. P. 20–26.Smith B.C.F., Cheema B.S.B., O’Sullivan A.J. et al. Resistance training during hemodialysis reduces C-reactive protein. Results from a randomized controlled trial of Progressive Exercise for Anabolism in Kidney Disease (the PEAK study) // J Am Geriatr Soc. 2005. Vol. 53. S13–S14.Smith B.C.F., Cheema B.S.B., O’Sullivan A.J. et al. Resistance training during hemodialysis reduces C-reactive protein. Results from a randomized controlled trial of Progressive Exercise for Anabolism in Kidney Disease (the PEAK study) // J Am Geriatr Soc. 2005. Vol. 53. S13–S14.Sun Y., Chen B., Jia Q., Wang J. The effect of exercise during hemodialysis on adequacy of dialysis // Zhonghua Nei Ke Za Z. 2002. Vol. 41. P. 79–81.Sun Y., Chen B., Jia Q., Wang J. The effect of exercise during hemodialysis on adequacy of dialysis // Zhonghua Nei Ke Za Z. 2002. Vol. 41. P. 79–81.Toussaint N.D., Polkinghorne K.R., Kerr P.G. Impact of intradialytic exercise on arterial compliance and B-type natriuretic peptide levels in hemodialysis patients // Hemodial Int. 2008. Vol. 12 (2). P. 254–263.Toussaint N.D., Polkinghorne K.R., Kerr P.G. Impact of intradialytic exercise on arterial compliance and B-type natriuretic peptide levels in hemodialysis patients // Hemodial Int. 2008. Vol. 12 (2). P. 254–263.Trisha L. Parsons, Edwin B. Toffelmire, Cheryl E. King-VanVlack. Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance // Arch Phys Med Rehabil. 2006. Vol. 87. P. 680–687.Trisha L. Parsons, Edwin B. Toffelmire, Cheryl E. King-VanVlack. Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance // Arch Phys Med Rehabil. 2006. Vol. 87. P. 680–687.Vaithilingham I., Polkinghorne K., Atkins R., Kerr P. Time and exercise improve phosphate removal in hemodialysis patients // Am J Kidney Dis. 2004. Vol. 43. P. 85–89.Vaithilingham I., Polkinghorne K., Atkins R., Kerr P. Time and exercise improve phosphate removal in hemodialysis patients // Am J Kidney Dis. 2004. Vol. 43. P. 85–89.Zaluska A., Zaluska W.T., Bednarek-Skublewska A., Ksiazek A. Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD) // Ann Univ Marie Curie Sklodowska. 2002. Vol. 57 (2). P. 342–346.Zaluska A., Zaluska W.T., Bednarek-Skublewska A., Ksiazek A. Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD) // Ann Univ Marie Curie Sklodowska. 2002. Vol. 57 (2). P. 342–346.

The authors declare that there are no conflicts of interest present.